# A hybrid effectiveness-implementation trial of a school based executive function treatment for transition age youth with autism

> **NIH NIH R01** · CHILDREN'S RESEARCH INSTITUTE · 2022 · $660,403

## Abstract

PROJECT SUMMARY
The proposed study is highly relevant to the 2017 Interagency Autism Coordinating Committee priorities to
improve transition to adulthood in autism spectrum disorders (ASD). It also advances NIMH’s mission to
develop interventions that: 1) assess the mechanisms through which an intervention produces therapeutic
change (Strategy 3.1); and 2) have been tested for effectiveness through pragmatic community-based trials
that examine implementation factors to improve the fit of the intervention (Strategy 3.3). Caring for transition-
age youth with ASD is a significant public health concern and the exit from high school is a period of amplified
risk. Individuals without intellectual disabilities (ID) comprise the fastest-growing subgroup of ASD and account
for two-thirds of the total population. Due to rising prevalence, there will be a 123% increase in the number of
youth with ASD exiting secondary school in the next decade. The educational system is increasingly the
primary service access point for youth with ASD, with as many of 90% served in public school settings. As
such, the transition from high school is often characterized as “falling over a cliff,” as youth with ASD lose these
educational and social supports. As few as 9% of autistic individuals without ID reach full functional
independence as adults, resulting in a loss to society, as well as to the youth and their families.
Impaired executive functions (EF) in ASD occur as a result of abnormalities in neural networks involving
prefrontal cortex, and are related to poor adult outcome. EF problems are pivotal targets for intervention
because they are common, linked to independence, and responsive to treatment. The proposed study will test
the effectiveness of a school-based cognitive behavioral EF intervention, Flexible Futures (FF), for transition-
age youth with ASD (AIM 1) and evaluate mechanisms of treatment change (AIM 2). FF targets flexibility and
planning skills and focuses on key functions needed for adult success: understanding one’s own thinking style
and advocating for accommodations; flexible problem-solving; time management; goal setting; developing
plans; monitoring progress. FF was designed from inception to be embedded in high schools and delivered by
school staff to improve generalization of skills, increase access to mental health care, and fill a gap in a lack of
evidence-based approaches to support postsecondary transition. A small, pilot randomized controlled trial
found students receiving FF made greater gains in planning, flexibility, adaptive, and classroom behavior when
compared to students receiving the usual ASD supports at school. This project capitalizes on the opportunity to
utilize pragmatic community trials to probe mechanisms of treatment change and explore barriers and
facilitators to implementation (AIM 3) to improve sustainable adoption and implementation of effective,
generalizable, evidence-based interventions. If successful, the proposed ...

## Key facts

- **NIH application ID:** 10331309
- **Project number:** 5R01MH124772-02
- **Recipient organization:** CHILDREN'S RESEARCH INSTITUTE
- **Principal Investigator:** Cara Pugliese
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $660,403
- **Award type:** 5
- **Project period:** 2021-02-01 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10331309

## Citation

> US National Institutes of Health, RePORTER application 10331309, A hybrid effectiveness-implementation trial of a school based executive function treatment for transition age youth with autism (5R01MH124772-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10331309. Licensed CC0.

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